仙人掌的故事——慢性精神病人復健的一種新途徑

THE STORY OF CAFÉ CACTUS: A NEW WAY TO THE REHABILITATION OF CHRONIC PSYCHOTIC PATIENTS

為了幫助慢性精神病人復健，作者嘗試輔導病人及其家屬尋求自力更生的計劃。由病人家屬捐款，少數病情穩定之病人發起、設計，開辦及經營一家命名為「仙人掌」的咖啡冰菓室及工作坊。自民國71年12月1日起，迄72年5月18日止，共計22位病人（年齡平均27.45±4.85歲；男性12位，女性10位；慢性精神分裂病15位，情感性精神病3位，其他4位），曾參與此一復健計劃。作者為他們進行每週一次的團體心理治療及門診追踪治療；同時給予評價。結果發現6位病人有顯著進步（其中2位已重返社會家庭）；中途退出者有4位；7位有輕度進步；其餘5位則沒有什麽改變。本研究發現若家屬的參與程度愈高，則病人的進步愈大。但是此計劃遭遇到以下幾項困難：（一）經費方面，營業收支不平衡；（二）家屬方面，參與的程度不足；（三）社會方面，對精神病人有相當強烈的偏見；（四）醫療方面，負擔太重，現實限制太多。作者參與這一為期半年的新型實驗性復健計劃，深切認為慢性精神病人的復健，必須獲得三個支持系統（醫療、家屬與社會）的合作與支持。為此作者們進一步率先在高雄市推動成立「康復之友協會」，期望能透過此一民間國體實現慢性精神病人自力更生的復健計劃。

In order to help the chronic psychotic patients to rehabilitate in the community, the authors have cooperated with some patients in remission and their families to establish a self-help rehabilitation program. A coffee shop, named as Café Cactus and regarded as a symbol of the program was opened in Kaohsiung on Dec. 1, 1982. The coffee shop was sponsored by the families and supported, in part, by the fund raised from the community. Twenty-two chronic patients (mean of age: 27.45±4.85 years; 12 males; 10 females; 15 chronic schizophrenic disorders; 3 major affective disorders; and 4 others) participated the program from Dec. 1, 1982 to may 18, 1983. The authors conducted interview group psychotherapy once weekly for the patients, who also took regular follow-up at the outpatient clinic weekly. A global evaluation of their mental and social condition 6 months later showed: 6 patients markedly improved; 7 mildly improved; 5 not changed; and 4 dropped. Another significant finding was that the more the families participated in the program, the better were the patients' outcome. However, there were some major problems encountered in the program: (1) financial difficulty; (2) hesitancy and passivity of the patient's family; (3) deep-seated stigmatization of mental disorders in the community; (4) limitation engendered by the current mental health care systems. In a tentative conclusion, the authors emphasize the importance of the cooperation and interdependence of the supporting systems in the rehabilitation program for chronic psychotic patients: psychiatric professional system, family supporting system, and social supporting system. This idea of Café Cactus will be taken-over and actualized further by a newly organized association—Kaohsiung's Association of Friends for Mental Rehabilitation (KAFMR).